Abstract
Objectives The patient is a 30 year old single Asian male physician in the US Navy with depression. He is physically healthy with a longstanding history of depersonalization symptoms including feelings of unreality, detachment, numbing, and feeling that his mind is empty of thoughts and memories. He started Bupropion XL 300 mg daily which improved his depressive symptoms though he continued to have depersonalization symptoms and was referred for treatment with rTMS. Methods Pretreatment Montgomery–Asberg Depression Rating Scale (MADRS) was 12, Cambridge Depersonalization Scale (CDS) was 149 (endorsed 20 of 29). He began right DLPFC 1 Hz rTMS. Depressive symptoms improved but depersonalization symptoms continued, with scores of MADRS 2 and CDS 100 (endorsed 17 of 29). He was thus switched to left DLPFC 10 Hz rTMS. Results He continued treatment through session 22 with scores of MADRS 2, and CDS 43 (endorsed 13 of 29). Conclusions There have been two case reports in which rTMS was effective in reducing symptoms of DPD, both using high frequency (20 Hz) rTMS to the left DLPFC. Key Message Given its effectiveness in our patient, the use of high frequency rTMS to the left DLPFC for treatment of DPD should be further explored.
Published Version
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